Tag Archives: injury management

Following a review by WorkCover WA, the workers’ compensation medical certificates have been revised and come into effect on 1 July 2014. They will now be known as Certificates of Capacity and replace the existing First, Progress and Final medical certificates currently used in WA.

WorkCover WA’s bulletin advises their intent is:

The certificates of capacity support the principle that work helps recovery. In general, work is beneficial to health and important for recovery. The certificates of capacity:

Assist GPs to focus on what the worker can do to remain in or return to work as soon as possible

Optimise the communication of information essential to support the worker’s recovery

Help GPs to articulate the worker’s progress and ongoing needs, assisting insurers to make informed decisions about the worker’s claim for workers’ compensation

Our view is no matter the format of the Certificates, the key elements remain:

Clear diagnosis

Best and timely treatment

Detailed capacity for work

Understanding by the doctor the availability of alternative or restricted duties if the injured employee has reduced capacity for work

An interesting article was published in Australian newspapers last week. It was the story of a truck driver who works for a mining company in WA. It is a story about rights: the rights of the injured worker and the rights of the employer. Reading the article is seems that there is much confusion out there about the WA Workers’ Compensation legislation. And as the articles title goes to show, for the person who has never had to deal with it, it can be a quagmire of lawyers, committees, departments, insurers and doctors.

The position we take at Aurenda is that the employer is a mining company. Their core business is mining. They have full intentions of keeping their employees and contractors safe and uninjured. Nobody wants the people who are doing work for them, to be hurt in anyway.

Some mining companies choose to keep their injury management entirely in-house with no reference to external specialists to assist them . As injury management specialists we believe this is toying with danger. As much as they have a human resources department to oversee it, the reality is that these are human resource specialists with a mining focus not injury management specialists.

We can see from this article that the people coordinating the injury management are attempting to do their best with good intentions. The reality is that they just don’t have the experience of a company like ours, where what we do is Workers’ Compensation and Injury Management day in, day out. We have seen just about every possible permeation of workplace injury and a library of case studies to guide us in times when the case is unusual.

A company we work with recently sent us some feedback for one of our injury management managers:

My background was in care. I worked on ‘the floor’ in a 24-hour care home in England for six years. In the last two years I was an Assistant Manager. I worked for two companies and was the Occupational Safety and Health (OSH) representative for both. I had input into the health and safety of both places. Most of my OSH knowledge is through on-the-floor experience so I am building up my training.

I came from England to Australia so I needed to learn all the different laws and regulations. I completed the 2-day Occupational Health and Safety Refresher Course at Aurenda to build up my knowledge. I also completed the Injury Management Course. A lot of knowledge that I now use in this position was covered in the course. I am currently studying for my Certificate IV in Health and Safety.

I have worked at Valued Independent People Inc (VIP) for about 10 months. VIP is a disability sector organisation that provides support for adults with disabilities and dual diagnosis mental health issues to participate in the community. I am the workplace Health and Safety Manager which includes being the Injury Management Coordinator. I work with the staff and our individuals making sure they are all practicing workplace health and safety and following manual handling guidelines.

On a daily basis I receive all the incident and accident forms. I investigate them all and where further actions arise from my investigations, I pass them on to the relevant people to address. I observe the workplaces making sure people are following the policies and procedures and people are happy in their work and write and amend policies and procedures as required. I provide support to all staff and they can ask me any questions. I manage the Health and Safety Representatives in the bases (VIP has four bases) and make sure they are up to date with their health and safety knowledge. I make sure they have access to the current OSH procedures.

In my Injury Management Coordinator role, if someone gets injured at work I follow the procedures in getting them to the doctor, and that is where Aurenda come in. They are the middleman between VIP and the workers compensation insurance company. I send them all the paperwork and they deal with the insurance company. They are there on the end of the phone if I need to ask any questions.

The Injury Management Course was three days full of information. Coming from England, there was no injury management side of things when I was there. I came into a job with minimal knowledge and the course was fabulous. I have been here nearly a year and managed to get quite a few claims through. I also understand what goes on even though I have a lot more to learn.

Aurenda are also very helpful and support me. In the course we went through all the company implications, the process that a claim needs to go through, the input that we need to have with the worker. Aurenda give you a lot of strategies to work with in different cases.

The other day we posted an American article on Linked In about a survey of injured workers and why they get compensation lawyers. The most surprising reason was that almost half the injured workers thought their claims had been contested, even though the paperwork had just begun and no decisions had yet been made.

The cause of this was put down to employer silence and lack of communication with the injured worker. As much as we would like to think that Australia is different to the USA, we know from experience that the same thing happens here.

When a workplace injury occurs, some employers will put their heads in the sand.

Although the law is very clear about the responsibilities of employers in relation to workplace injuries, when it does happen, some employers don’t really know how to handle it. Unfortunately they choose the “don’t say anything” route.

As in any work relationship, communication is the key to understanding by both employer and employee.

So before the unspeakable happens, what is the best way of avoiding this lack of communication?

Educate yourself and staff about who will deal with workplace injuries and what processes will be followed.

Aurenda’s Injury Management Coordinator Course is employer-focused and designed for anyone who has responsibility for supervising or managing injured workers in the workplace. This is an essential program to learn practical skills to proactively manage injured workers and their claims.

Aurenda’s next course is scheduled for the 27th, 28th February and 1st March. (Wed, Thurs, Fri)

A common scenario when we at Aurenda first meet a prospective client is that a poor claims history has led to a whopping increase in the organisation’s workers’ compensation premium. Sure, the immediate consequences of a poor year are often apparent in the direct increase in premium – but have you considered the past and future cost implications as well?

Past

Contrary to popular belief, it only takes one bad year of workers’ compensation costs to have an impact on your workers’ compensation premium, particularly in a hardening insurance market.

Higher workers’ compensation costs can be attributed to one or many variables, including:

Increase in the frequency and/or severity of injuries

Increase in the number of claims as a result of changing business conditions

Lack of control over the injury and claims management process

Lack of internal responsibility and/or accountability for managing and supervising the recovery of injured workers

A single claim that blows out because of severity of injury and/or complexity of the issues surrounding the claim

Whilst the primary concern with a premium increase is centred on the immediate financial impact on the bottom line of the organisation, there are very good reasons to remain focussed on the past.

Is there a Claims Experience Discount (CED) for the previous policy period?CEDs can be worth as much as 25% of premium – do you know what your CED is worth? CEDs are paid on a sliding scale – what are the minimum and maximum thresholds for achieving all or part of the CED on the previous policy period? Depending on the actual severity of claims in the previous period, and ratio of paid costs to outstanding estimates, you may still be in a position to obtain some CED from your previous premium at the next insurance renewal.

Future premiums will be calculated on the basis of past claims history.Workers’ compensation is a long-tail insurance product so you need to continue to manage all open claims to achieve the best possible outcome for both the injured worker and your future premium. Outstanding estimates are just that: “estimates”. Anything that can be done to get a better ‘picture’ of the final outcome of the claim in terms of actual paid costs will assist your broker to negotiate the next premium. Finalisation of outstanding claims is obviously the goal, but other strategies can also result in far lower estimates for claims that will remain open over a longer period.

Present

As Tony Robbins says, “If you do what you’ve always done, you’ll get what you’ve always gotten”. Now that you’ve absorbed a massive hit to your premium, what are you going to do about it?

Understanding the reasons for the escalation in claims costs is a good starting point. They could be the consequence of one or many of the reasons outlined above. A note of caution: don’t lay (all) the blame on third parties. The Western Australian workers’ compensation system allows for an incredible amount of employer input and direction into the management of workplace injuries and claims. If, as a business, you are not aware of this or you are not exercising your rights and responsibilities in this area, then you need to understand what they are and how to use them to reduce claims costs – and achieve better outcomes for your injured employees.

In addition, there’s the potential CED on the new premium – likely to be worth much more than last year, now that your premium has increased. Do you know what the financial targets are to achieve the CED? What strategies will you put in place to do something different this year?

Future

Future premiums are affected by past and present claims costs – pure and simple. You may be reeling from a premium increase right now, but if you do nothing to change how you control claims costs going forward, you haven’t seen the worst of it. It can take up to five years of good claims history to counter the impact of one bad year on premiums.

Not only will you face an immediate increase in premium, but the recurring impact means that you may be paying the price for years to come – even without consideration for increases due to the growth of the business.

Of course, the greater the impact you make on reducing claims costs immediately, the lower the potential long-term recurring impact on premiums.

What Now?

Consider the scenario of a company with a gazetted premium rate equating to $250,000. With a 50% loading due to a poor claims history, the actual premium cost is $375,000 in the first year. Assuming that it takes this company five years to get back to their Gazette Rate, the total additional premium paid over that period is $375,000. What could you do with that money?

There are three key factors to address the impact of claims costs on premiums:

Understand which drivers are determining your claims costs – it may be any or all of those outlined above.

Establish financial targets to reduce claims costs and achieve CEDs – and monitor these targets in conjunction with the people who have responsibility for injury management in your workplace.

As Einstein said, “Insanity is doing the same thing, over and over again, but expecting different results”. Contact Deb Macksy at Aurenda on (08) 6389 8900 or email dmacksy@aurenda.com to discuss how Aurenda can assist you to stop the insanity.

The supporting Workers’ Compensation and Injury Management Amendment Regulations 2012 are also effective from 1 August 2012.

These legislative changes clarify common law insurance requirements under the Workers’ Compensation and Injury Management Act 1981 (the Act) as a result of legal uncertainty over the scope of the insurance obligation introduced on 1 October 2011 by the Workers’ Compensation and Injury Management Amendment Act 2011.

The legislative changes:

Clarify the definition of ‘damages’ for insurance purposes.

Provide that employers do not require common law insurance under the Act for ‘deemed workers’ – that is, workers of whom the employer would not be the employer but for being deemed an employer under sections 175 or 175AA for compensation purposes.

Retrospectively preserve insurance arrangements for employers of deemed workers insured under public liability insurance arrangements by preventing the denial of cover on the basis that the employer was required to be insured under the Act from from 1 October 2011 to 1 August 2012.

Limit, modify or exclude any requirement to hold insurance in respect of liabilities in prescribed circumstances or out of prescribed events. These are consistent with current employer indemnity arrangements and include:

a $50 million insurance limit on common law liabilities arising out of a single event.

an insurance exclusion regarding any liability to pay compensation or damages arising out of events such as war, military or usurped power.

an insurance exclusion regarding any liability to pay damages in respect of injuries occurring outside of Australia or in a jurisdiction outside of Australia.

an insurance exclusion regarding any liability to pay compensation or damages in respect of specified industrial diseases arising from employment in any mine or mining operation.

Preserve terms, conditions and exclusions in employer indemnity policies to the extent these comply with the corrective amendments in the Amendment Act and Regulations.

For further information on the legislative changes please contact Mr Kevin Gillingham, Manager Policy and Legislative Services at WorkCover WA, on 9388 5640.